Why seeing more patients doesn’t equal greater productivity

Physicians are increasingly being squished. As reimbursement rates decrease or remain stagnant, many people think the solution is to see more patients. Unfortunately, this just doesn’t work in medicine. Those who tend to see patients as consumers seem to also be the same ones who think rushing patients in and out of the office to increase numbers is the answer.

Here are six reasons why seeing more patients is not the solution:

Patients are living longer with more chronic and complicated diseases.

They need more time with physicians and other healthcare providers than ever before. Patients usually have more diseases to monitor and potential complications to watch out for. Additionally, patients are often on more medications, and physicians need more time to discuss potential side effects and interactions. Shortening visits even further means more patients leave the exam room with questions unanswered and conditions undetected. This takes more time down the road. And it sets up the stage for missed diagnoses and unnecessary complications.

Documentation suffers.

When we see more patients, we have less time to document, and we are already struggling against an ever-increasing charting burden. We need to report certain metrics to meet MIPS/MACRA requirements. We can’t see more patients and record more data at the same time.

Patients are more educated.

Patients often conduct their own internet research on Dr. Google before they come to see us. This does not save time in most cases. Rather, patients come in with many questions that need answers. If we address their concerns up front, they don’t need to call back with additional questions that weren’t answered at the time of their visit or return to have us look at something that was left unexamined.

More patients equal less time to answer all of patients’ concerns in one visit.

Some doctors now limit the number of problems patients can discuss at one visit. I am a family doctor, and often patients may have many disparate concerns that end up being related. For example, a patient may be concerned about why she is so tired and why her legs are swelling. Those are two concerns. However, if we listen to all her concerns, she may also tell us that her hair is falling out and she has trouble swallowing. These added concerns lead me to make the diagnosis of hypothyroidism.

Patient satisfaction suffers.

When patients feel we don’t spend enough time with them or listen to all their concerns, they are not happy. They come to use and are worried about a problem, stressed out about life events or just wanting to make the best decisions to stay healthy. We can do much to ease that — if we have time.


When we rush patients in and out to try to increase numbers, we are not able to comfort our patients. Again, this may lead to follow-up calls. Or worse, the patient writes negative reviews about us online or looks for another doctor who can give them 5 extra minutes, both of which can cause our profits to decrease. While we can’t make every patient happy, we should do our best to listen and try to help them find answers.

Physician burnout is increasing.

Everyone is talking about the high degree of burnout among physicians. Most of us are already operating at full steam. Trying to pile more on us is only going to make this problem worse. When we see more patients, we often are left with piles of paperwork to complete after-hours due to the endless load of increasing documentation requirements.

Doctors are human. We need rest, too. We have families, and they need us too. Unless we are allowed to take care or ourselves and our loved ones, our health will suffer. An ailing doctor is not an effective one.

While many in the C-suite think seeing more patients can boost productivityand profits, they fail to see the reality those on the frontlines face every day. Pushing more patients through a dysfunctional healthcare system is not helping anyone, patients or healthcare providers alike. Executives at organizations may see an initial boon to the bottom lines, but over time they are going to burn their resources (i.e., doctors) to the ground. Then they will be left with a crowd of patients in the waiting room and no one left to take care of them.

If we want to improve physician efficiency and productivity, we need to fix our broken healthcare system first.

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Get the Right Answer from Analytics by Asking the Right Questions

For all the promise of meaningful positive change in the quality, effectiveness, and cost of healthcare that analytics can bring, there is a downside.


Analytics programs are only good at transforming data into information. It is up to you to make it actionable. For many users, reports selected by software developers and their authors may not fit your unique needs. Selecting what looks like the right report off a menu is far less important than asking the right question and using system capabilities to get the right answers.


The key to effectively using analytics is not to ask which, but, to ask why.


Here’s an example of asking the right question and getting a totally unexpected answer:

Chronic Back Pain Conundrum

Standard claims analytic reports showed that the top diagnosis—and cost—in our patient population is chronic back pain. It breeds co-morbidity like weeds in an unkempt lawn and costs compound as does misery and debilitation.


In a deeper dive, standard reports provided detailed information on who, what, where, and when.


The most important questions, which the report did not answer, are: How? and Why?


But it did provide a clue. A substantial number of patients had either undergone physical therapy or had seen a chiropractor, but not both.


The natural question: Was one more effective, or expensive, than the other?


The answer was a complete surprise, going against convention, expectation, and even published evidence-based medicine and health plan protocols.


A customized study of thousands of patients showed that it is less expensive for those chronic back pain sufferers to see a chiropractor than to undergo physical therapy. And, not by a little. By over $2,400 per year. Each.


Another study approach corroborated the result.


That answered the how.


The “why” took more legwork.

The Value of Caring

Why is a therapy based upon decades of medical convention and science so resoundingly outperformed by one historically on its fringe? Whether science or psychology, results are results.


But this outcome should not have been so unexpected. The chiropractic practice model is warm, welcoming, caring, and sincere, and patients respond by feeling—and doing—better.


Dozens of studies show that staff and physician attitude materially affect everything from procedural outcomes to patient engagement in their treatment.


So fundamentally, good experience equals positive attitude. Positive attitude equals positive results, even in cancer patients.

Process vs. Curiosity

We are all process-oriented by profession—physicians, clinicians and administrators alike.


We are also curious by nature, our curiosity stifled by burdensome regulations, protocols, conventions, conceptions, culture, bureaucrats, litigators, regulators, and behavioral mores thrust upon us by the nature of healthcare, which wants us to be regimented and in lockstep.


As Thomas Jefferson famously said, “A little rebellion now and then is a good thing.”

Rebel. Be curious. Explore. Make the world a better place.

Inquisitiveness rarely leads to inquisition. It does lead to progress.

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5 Ideas for Managing Physicians' Outside Activities

Almost every physician contract I review contains a provision limiting the physician’s ability to engage in “outside activities,” such as consulting, speaking, outside research, expert witness testimony, or even moonlighting.


However, physician practices rarely go far enough in monitoring their physicians’ outside activities and taking the steps necessary to protect the practice from possible liability, including conflicts of interest that may implicate federal law.

Recently, I worked with a client that permitted its physician-employees to engage in outside activities as long as they “disclosed” such activities to the employer. One physician, who rendered research activities through a separate entity he owned, ended up being subpoenaed in a government investigation. Unfortunately, the practice was also drawn into the investigation and the physician’s counsel was able to make a claim on the practice’s directors and officers liability insurance policy for such outside activities.

For many practices, the above scenario is a real possibility. Physician practices must take the time to evaluate their policies related to “outside activities."

The following are some ideas to consider:

1. Every employment agreement should restrict a physician from engaging in any outside activities without written approval by the employer. Although many physicians (and their counsel) find this unfair, there are many reasons why this is reasonable to require. Simple “notice” of the outside activity is insufficient to protect the practice in most cases and may be deemed to automatically suggest the activity was approved/consented to by the practice, thus implicating the practice’s insurance coverage.

2. The practice should have every physician complete a questionnaire concerning outside affiliations and organizations, at least annually. The practice should work with counsel, taking into account the practice’s specialty, to develop the appropriate questions to include. For example, the questionnaire should inquire whether each physician (or an immediate family member) owns, holds a position with, and receives any payments, royalties or other amounts from an outside healthcare entity unaffiliated with the practice. It is also important to know whether such entity does business directly or indirectly with the practice, particularly as it may relate to pharmaceutical, device and similar companies.

The physician should be required to advise the practice of any changes within 30 days and failure to comply, and/or falsification of responses, should be possible grounds for termination. The information collected from the questionnaire should be closely reviewed by the practice, with counsel as appropriate, to assure that there are no potential legal issues to be addressed (such as Stark self-referrals, Anti-Kickback, Sunshine Act, etc.).

3. Every practice should have a policy advising on the practice’s stance regarding outside activities. For example, the policy might set forth the following: the process for obtaining consent to outside activities; how payments are handled’ the amount/type of insurance required for the outside activity; events that require notice to the practice (i.e. investigation); clarification on intellectual property ownership; a requirement that the practice be indemnified in writing by the physician (and outside entity) related to such outside activity; and a requirement that the physician provide any written agreement with the outside entity for the practice to review.

4. In many cases, practices mandate, as a condition of approval, that the agreement for the outside services incorporate the practice’s own “Terms and Conditions,” as an exhibit. This exhibit then incorporates into the third-party agreement the practice’s desired terms related to indemnification language, intellectual property rights, insurance, control over the physician, etc. I have found this to be an effective approach to protect my clients, but it must be properly done to be sure the practice’s document controls.

5. Make sure the practice has adequate insurance coverage and determine what type of language might be required to minimize risk of a claim being successfully brought for a physician’s outside services. Determine whether each outside activity needs to be specifically excluded from the policy.

Because every practice is different, it is important to evaluate its specific needs and concerns when developing appropriate policies on outside activities. Any time and legal expense required to develop such practice documents are likely to be far less than the possible consequences of failing to so.

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